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• W2912202719 abstract "Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosisJournal of HepatologyVol. 69Issue 5PreviewHepatic alveolar echinococcosis (AE) is a lethal infectious disease caused by the larval stage of Echinococcus multilocularis (E. multilocularis). This severe disease remains a major public health issue in pastoral areas in China, Turkey, Central Asia, the Mediterranean and some European countries.1 AE is usually chronic and asymptomatic while primary hepatic involvement presents with a mortality rate of 75% to 90% after 10 to 15 years if untreated. So far surgery associated with albendazole medication has been considered a major radical procedure for clinically diagnosed patients with AE. Full-Text PDF The authors of the article “Ex vivo liver resection and autotransplantation (ELRA) as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis” describe an overall mortality rate of 12% after a mean follow-up of 22 months.[1]Aji T. Dong J.-H. Shao Y.-M. Zhao J.-M. Li T. Tuxun T. et al.Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis.J Hepatol. 2018; 69: 1037-1046https://doi.org/10.1016/j.jhep.2018.07.006Abstract Full Text Full Text PDF Scopus (61) Google Scholar The authors come to the conclusion that ELRA is an effective alternative to liver transplantation and is a feasible surgical option for patients with end-stage alveolar echinococcosis (AE). The contents of article have to be regarded with caution, especially by European clinicians, given that essential information is missing. Although the selection process used to propose this procedure to patients, with very advanced AE, is properly described, comparison of its outcome with that of patients from the same center with standard in situ resection, and with anti-infective treatment, without surgery, is not available in this article. The conclusions are based on the assumption that liver transplantation is the only therapeutic alternative to resection in these patients and that such high mortality is acceptable. Results after allotransplantation are indeed associated with significant mortality, recurrence of disease, and the procedure is limited by the organ shortage that affects all countries, including China.2Koch S. Bresson-Hadni S. Miguet J.-P. Crumbach J.-P. Gillet M. Mantion G.-A. et al.Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report.Transplantation. 2003; 75: 856-863https://doi.org/10.1097/01.TP.0000054230.63568.79Crossref PubMed Scopus (136) Google Scholar, 3Hwang R. Liou P. Kato T. Ex vivo liver resection and autotransplantation: An emerging option in selected indications.J Hepatol. 2018; 69: 1002-1003https://doi.org/10.1016/j.jhep.2018.09.005Abstract Full Text Full Text PDF Scopus (16) Google Scholar However, indications for liver allotransplantation for AE have considerably decreased in the European endemic areas of AE (only 1/111 in Bern [Switzerland] and 2/172 since 2000 in Besançon [France]), and the results of non-surgical treatment strategies in Europe are far better than presumed by the authors. Long-term treatment using albendazole alone or in conjunction with perendoscopic biliary stenting is a valuable option with a higher survival rate than that reported by the authors, as shown from an analysis of 2 distinct cohorts of European patients (Fig. 1). However, these excellent results may be because of the patients assessed, who were generally older and diagnosed with disease at an earlier stage than in China.[4]Kern P. Menezes da Silva A. Akhan O. Müllhaupt B. Vizcaychipi K.A. Budke C. et al.Adv Parasitol. 2017; 96: 259-369https://doi.org/10.1016/bs.apar.2016.09.006Crossref PubMed Scopus (255) Google Scholar Chinese patients studied in Aji et al.’s article[1]Aji T. Dong J.-H. Shao Y.-M. Zhao J.-M. Li T. Tuxun T. et al.Ex vivo liver resection and autotransplantation as alternative to allotransplantation for end-stage hepatic alveolar echinococcosis.J Hepatol. 2018; 69: 1037-1046https://doi.org/10.1016/j.jhep.2018.07.006Abstract Full Text Full Text PDF Scopus (61) Google Scholar are more similar to those diagnosed 30 years before in the same European centers;2Koch S. Bresson-Hadni S. Miguet J.-P. Crumbach J.-P. Gillet M. Mantion G.-A. et al.Experience of liver transplantation for incurable alveolar echinococcosis: a 45-case European collaborative report.Transplantation. 2003; 75: 856-863https://doi.org/10.1097/01.TP.0000054230.63568.79Crossref PubMed Scopus (136) Google Scholar, 5Bresson-Hadni S. Vuitton D.A. Bartholomot B. Heyd B. Godart D. Meyer J.P. et al.A twenty-year history of alveolar echinococcosis: analysis of a series of 117 patients from eastern France.Eur J Gastroenterol Hepatol. 2000; 12: 327-336Crossref PubMed Scopus (169) Google Scholar in addition, the necessary strict follow-up of the anti-infective treatment which is the rule in Europe and includes surveillance of the occurrence of AE biliary/vascular complications and of albendazole adverse effects, and plasma albendazole sulfoxide measurement,[6]Vuitton D. Bresson-Hadni S. Alveolar echinococcosis: evaluation of therapeutic strategies.Expert Opin Orphan Drugs. 2014; 2: 67-86Crossref Scopus (37) Google Scholar is likely more difficult in Chinese patients living in remote villages far from reference centers. These considerations have to be taken into account, as European surgeons may be tempted by the impressive but risky procedure proposed by their Chinese colleagues. The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details. The authors wish to thank Florent Demonmerot, Marc Puyraveau, and Joséphine Moreau for the survival curves, as well as all clinicians in charge of the patients in Bern and Besançon. The following are the Supplementary data to this article: Download .pdf (.14 MB) Help with pdf files Supplementary Data 1" @default.
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• W2912202719 title "Is ex vivo liver resection and autotransplantation a valid alternative treatment for end-stage hepatic alveolar echinococcosis in Europe?" @default.
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